| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
51 |
51 |
$6K |
| A6229 |
Gauze, impregnated, water or normal saline, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
12 |
12 |
$592.22 |
| A6251 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
12 |
12 |
$13.44 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
50 |
50 |
$0.00 |